红斑狼疮或血管炎患者使用环磷酰胺治疗后出现带状疱疹：发生率、危险因素和抗病毒预防的效果。
Zoster after Cyclophosphamide for Systemic Lupus Erythematosus or Vasculitis: Incidence, Risk Factors, and Effect of Antiviral Prophylaxis.
机构信息
From Service de Maladies Infectieuses et Tropicales; Département de Néphrologie et transplantation d'organes, et Centre de Référence Maladies Rénales Rares; Service de Médecine Interne; CIC 1436; Service de Rhumatologie et Médecine Interne; Service de Pneumologie; Service de Médecine Interne, Fédération Digestive; Département d'information médicale; Service de Virologie, CHU de Toulouse; UMR 1027, Inserm-Université de Paul Sabatier, Toulouse, France.
C. Garnier, MD, Service de Maladies Infectieuses et Tropicales, CHU de Toulouse; D. Ribes, MD, Département de Néphrologie et transplantation d'organes, et Centre de Référence Maladies Rénales Rares, CHU de Toulouse; D. Chauveau, MD, PhD, Département de Néphrologie et transplantation d'organes, et Centre de Référence Maladies Rénales Rares; A. Huart, MD, Département de Néphrologie et transplantation d'organes, et Centre de Référence Maladies Rénales Rares, CHU de Toulouse; G. Pugnet, MD, PhD, Service de Médecine Interne and CIC 1436, CHU de Toulouse, and UMR 1027, Inserm-Université de Paul Sabatier; D. Adoue, MD, Service de Rhumatologie et Médecine Interne, CHU de Toulouse; G. Prevot, MD, Service de Pneumologie, CHU de Toulouse; L. Alric, MD, PhD, Service de Médecine Interne, Fédération Digestive, CHU de Toulouse; P. Delobel, MD, PhD, Service de Maladies Infectieuses et Tropicales, CHU de Toulouse; H. Derumeaux, MD, PhD, Département d'information médicale, CHU de Toulouse; C. Mengelle, MD, Service de Virologie, CHU de Toulouse; L. Sailler, MD, PhD, Service de Médecine Interne and CIC 1436, CHU de Toulouse, and UMR 1027, Inserm-Université de Paul Sabatier; G. Moulis, MD, PhD, Service de Médecine Interne and CIC 1436, CHU de Toulouse, and UMR 1027, Inserm-Université de Paul Sabatier.
出版信息
J Rheumatol. 2018 Nov;45(11):1541-1548. doi: 10.3899/jrheum.180310. Epub 2018 Jul 15.
OBJECTIVE
To assess the incidence and the risk factors for zoster in patients exposed to intravenous cyclophosphamide (CYC) for systemic vasculitis or systemic lupus erythematosus (SLE), as well as the protective effect of prophylaxis by valacyclovir (VCV).
METHODS
This retrospective study included all adults treated by intravenous CYC for SLE or systemic vasculitis between 2011 and 2015 at Toulouse University Hospital, France. Zoster occurrence was recorded using medical chart review, laboratory data, and patient interviews. Univariate Cox models were computed to assess the risk factors for zoster and the protective effect of prophylaxis by VCV.
RESULTS
The cohort consisted of 110 patients (81 systemic vasculitis and 29 SLE). During a mean followup of 3.4 years after CYC initiation, 10 cases of zoster occurred, leading to an overall incidence of 27.9/1000 patient-years (95% CI 15.2-50.6); it was 59.4/1000 patients (95% CI 27.5-123.6) during the year after CYC initiation. Four patients experienced persistent postherpetic neuralgia. Probable risk factors were lymphopenia < 500/l at CYC initiation (HR 5.11, 95% CI 0.94-27.93) and female sex (HR 4.36, 95% CI 0.51-37.31). The incidence was higher in patients with SLE (HR as compared with systemic vasculitis patients = 2.68, 95% CI 0.54-13.26). None of the 19 patients exposed to VCV during the followup developed zoster.
CONCLUSION
The incidence of zoster is high in systemic vasculitis and in patients with SLE exposed to intravenous CYC. CYC may favor postherpetic neuralgia. Prophylaxis by VCV should be considered, particularly in cases of lymphopenia < 500/l at CYC initiation and during the year after.
目的
评估接受静脉用环磷酰胺（CYC）治疗系统性血管炎或系统性红斑狼疮（SLE）的患者中带状疱疹的发生率和风险因素，以及伐昔洛韦（VCV）预防的保护作用。
方法
本回顾性研究纳入了 2011 年至 2015 年期间在法国图卢兹大学医院接受静脉用 CYC 治疗的所有成人患者。通过病历回顾、实验室数据和患者访谈记录带状疱疹的发生情况。采用单变量 Cox 模型评估带状疱疹的风险因素和 VCV 预防的保护作用。
结果
队列包括 110 例患者（81 例系统性血管炎和 29 例 SLE）。在 CYC 起始后平均 3.4 年的随访期间，发生了 10 例带状疱疹，总发生率为 27.9/1000 患者年（95%CI 15.2-50.6）；在 CYC 起始后 1 年内为 59.4/1000 例患者（95%CI 27.5-123.6）。4 例患者出现持续性带状疱疹后神经痛。可能的风险因素包括 CYC 起始时淋巴细胞计数 < 500/μl（HR 5.11，95%CI 0.94-27.93）和女性（HR 4.36，95%CI 0.51-37.31）。与系统性血管炎患者相比，SLE 患者的发生率更高（HR 为 2.68，95%CI 0.54-13.26）。在随访期间接受 VCV 暴露的 19 例患者中均未发生带状疱疹。
结论
接受静脉用 CYC 治疗的系统性血管炎和 SLE 患者中带状疱疹的发生率较高。CYC 可能促进带状疱疹后神经痛。应考虑使用 VCV 预防，尤其是在 CYC 起始时淋巴细胞计数 < 500/μl 和 CYC 起始后 1 年内。
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